Research Article: Patterns and Determinants of Care-Seeking for Antepartum and Intrapartum Complications in Rural Bangladesh: Results from a Cohort Study

Date Published: December 20, 2016

Publisher: Public Library of Science

Author(s): Rasheda Khanam, Andreea A. Creanga, Alain K. Koffi, Dipak K. Mitra, Arif Mahmud, Nazma Begum, Syed Mamun Ibne Moin, Malathi Ram, Md Abdul Quaiyum, Saifuddin Ahmed, Samir K. Saha, Abdullah H. Baqui, Kevin Mortimer.


The burden of maternal complications during antepartum and intrapartum periods is high and care seeking from a trained provider is low, particularly in low middle income countries of sub-Saharan Africa and South Asia. Identification of barriers to access to trained care and development of strategies to address them will contribute to improvements in maternal health. Using data from a community-based cohort of pregnant women, this study identified the prevalence of antepartum and intrapartum complications and determinants of care-seeking for these complications in rural Bangladesh.

The study was conducted in 24,274 pregnant women between June 2011 and December 2013 in rural Sylhet district of Bangladesh. Women were interviewed during pregnancy to collect data on demographic and socioeconomic characteristics; prior miscarriages, stillbirths, live births, and neonatal deaths; as well as data on their ability to make decision to go to health center alone. They were interviewed within the first 7 days of child birth to collect data on self-reported antepartum and intrapartum complications and care seeking for those complications.

Self-reported antepartum and intrapartum complications among women were 14.8% and 20.9% respectively. Among women with any antepartum complication, 58.9% sought care and of these 46.5% received care from a trained provider. Of the women with intrapartum complications, 61.4% sought care and of them 46.5% did so from a trained provider. Care-seeking for both antepartum and intrapartum complications from a trained provider was significantly higher for women with higher household wealth status, higher literacy level of both women and their husbands, and for those living close to a health facility (<10 km). Women’s decision making ability to go to health centre alone was associated with untrained care only for antepartum complications, but was associated with both trained and untrained care for intrapartum complications. Nearly 40.0% of the women who experienced either an antepartum or intrapartum complications did not seek care from any provider and 11.5% -14.9% received care from untrained providers, primarily because of economic and geographic barriers to access. Development and evaluation of context specific, cost-effective, and sustainable strategies that will address these barriers to access to care for the maternal complications will enhance care seeking from trained health care providers and improve maternal health.

Partial Text

Despite substantial improvements in global maternal mortality, complications during antepartum and intrapartum periods remain high, particularly in low middle income countries (LMICs) of sub-Saharan Africa and South Asia [1–3]. The actual burden of maternal complications during antepartum and intrapartum periods is not known; the literature provides varying estimates. For every maternal death, it is estimated that about 20 women experience acute or chronic complications due to maternal causes with substantial impact on physical, psychological, social and economic outcomes [4]. According to another estimate, approximately 15.0% of all pregnant women or about 20 million women annually around the world experience acute severe obstetric complications, including haemorrhage, pre-eclampsia, eclampsia, obstructed or prolonged labour, puerperal sepsis, and abortion [2, 5, 6]. There is a need for additional studies to more precisely estimate the burden of maternal complications. In addition to affecting mothers’ own health, maternal complications have also been shown to affect the health of the fetus and newborn. The risk of perinatal mortality increases with complications such as maternal sepsis, pre-eclampsia/eclampsia, severe anaemia, placental abruption, or ruptured uterus [7, 8]. Therefore, timely recognition of antepartum and intrapartum complications and prompt care-seeking from trained providers are crucial in improving maternal as well as fetal and newborn health.

Of the 28,960 women who were approached to participate in the study, 79 (<0.3%) refused participation. Among 28,622 women, about 15.2% were lost to follow up. The most important reasons were censoring of women (8.1%) i.e., the woman’s pregnancy did not end when the study follow-up ended and 4.6% women were absent during scheduled visit at day 59 after delivery (Fig 2). The mean (± SD) age of enrolled women was 26.9 (± 6.0) with a range of 14–55 years. About a quarter of the study women and more than third of their husbands had no formal education. In this population-based cohort of Bangladeshi women, the burden of self-reported serious antepartum and intrapartum complications was high at 14.8% and 20.9%, respectively. Although a majority of women sought care and almost half did so from a trained provider for both antepartum and intrapartum complications. For antepartum and postpartum complications, 41.1% and 38.6% of women did not seek any care, respectively.   Source: